Quality Measures for Meaningful Use and Beyond

1. Quality Measures for Meaningful Use and Beyond Melissa Swanfeldt, Associate Vice President, MEDITECH Zahid W. Butt, MD, FACG, CEO, Medisolv

2. Stage 1 Clinical Quality Measures for Meaningful Use • Quality Measure Trends Beyond MU • What we know about Stage 2 CQMs

3. Stage 1 Clinical Quality Measures for Hospitals 15 e-Measures • Stroke • VTE • ED Throughput

4. Challenges • Value sets use vocabularies not used widely • in EHRs (SNOMED CT, RxNorm) • e-Measure specifications contain multiple • errors and inconsistencies • HITSP Specification TN906 has over 500 data • elements in the 15 measures • Data capture must be in discrete fields • Impact on workflow for clinicians

5. Best Practice Guidance for Data Capture • Nomenclature Mapping • LOINC • SNOMED CT and ICD-9 for problems • RxNorm • Exclusions • Contraindications • Clinical trials ARRA Quality Reporting Page

6. Stage 1 CQM’s for Eligible Professionals 44 Ambulatory Clinical Quality Measures • 3 Core/3 Alternate Core • 3 Additional Measures • Use of MPM Clinical Reporting Tool for Stage 1 • Performance and Outcomes are not measured

7. Stage I MU Quality Reporting Prepare or Procrastinate • Clinician Education is Essential • Sustainable Workflow Design/Redesign • Minimize Data Capture Burden • Leverage Clinical Decision Support - CPOE • “Problem Lists” Reconciliation • Performance Rate Analysis • (Errors vs. Low Performance)

8. All Measure Results in One Simple Screen Page 8

9. Drilldown to Analyze Results Page 9

10. Review Non-Compliant Cases Page 10

11. Why have 50+ Hospitals Chosen Medisolv for Meaningful Use Reporting? “Medisolv team was outstanding. They offered clinical as well as programming resources. They are VERY knowledgeable about the measure requirements, clinical processes as well as reporting details. We began building for the quality measures in May and our 90 day period began June 1. The Medisolv team was very engaged and responsive. …we would likely not be attesting for stage I this year without their help.” From the MUSE List Server Pamela Feeler, Director of Nursing Informatics - Phelps County Regional Medical Center

12. Quality Measurement Trends • Quality Reporting is Central to Healthcare • CMS Programs: IQR,OQR,PQRS,VBP • Accreditation (The Joint Commission) • ARRA Meaningful Use • ACA & National Quality Strategy • NHSN & State Initiative • Performance Matters • Pay for Performance • Public Perception/Reporting

13. THE QUALITY “ENTERPRISE”

16. Quality e-Measures • E-Measures Replace Abstracted/Paper Measures • “Dual Measures Environment” Will Persist for Many Years • Patient Level Data Submission • Certification will Include Algorithm Validation • New Auditing Methods and Criteria

17. OIG 2012 Work Plan Priorities Reliability of Hospital-Reported Quality Measure Data We will review hospitals’ controls for ensuring the accuracy and validity of data related to quality of care that they submit to CMS for Medicare reimbursement. Hospitals must report quality measures for a set of 10 indicators established by the Secretary as of November 1, 2003. (The Social Security Act, § 1886(b)(3)(B)(vii).) A reduction in payments of 0.4 percent to hospitals that did not report quality measures to CMS was established by the MMA, § 501(b). The reduction was increased to 2 percent effective at the beginning of FY 2007. (Social Security Act, § 1886(b)(3)(viii), as added by the Deficit Reduction Act of 2005 (DRA), § 5001(a).) We note that the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) also expands the existing quality initiative. (OAS;W-00-11-35438; various reviews; expected issue date: FY 2012; new start; Affordable Care Act) http://oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf

18. Dual Environment Challenges • Quality Measurement Governance • Data Collection Issues • Performance Rate Validation • Benchmarking Issues • Patient Level Data Submission Issues • Public Reporting Issues

19. Clinician Education Measure Implementation AQA, HQA, QASC Physician & Hospitals, etc. Health Plans and CMS HIT vendors HIT Support CME/CPPD Evaluation Evidence and CPG Generation Measure Development PCPI & Specialty Assoc. NCQA/JC CMS Measure Endorsement NQF AQA-AQA HIT-Healthcare Information Technology CME-Continued medical evaluation HQA-Hospital Quality Alliance CPG-Clinical practice guidelines NCQA/JC-National Committee on Quality CPPD-Continued physician professional Assurance/Joint Commission development QASC-Quality Alliance Steering Committee

20. VTE 1 Workflow Summary Physician Order Physician Admission Order Clinical Trial / Comfort Measures Contraindication VTE Prophylaxis SNOMED Mechanical Prophylaxis Pharmacologic Prophylaxis SNOMED Nursing Documentation EMAR/BMV RXNORM SNOMED

21. The Tale of Two Problem Lists Problem List in Patient Summary Panel (Clinical Review) ICD 9 or SNOMED linked to Mnemonic Current vs. Historical Attribute Selection Active vs. Resolved Ordinality (Reason For Admission always first) Coded Visit Abstract ICD 9 with Mapping to SNOMED

22. New Workflow Paradigms

23. Stage 2 Clinical Quality Measures • 113 NQF Endorsed Measures • 39 Eligible Hospital Measures • 83 Eligible Professional Measures • Practice • Radiology • Oncology

24. MEDITECH Prepares for Stage 2 Quality Reports • Specification Review • Best Practice Workflows • Focus Groups • Nomenclature Mapping Tools

27. Medisolv Quality Expertise • The Joint Commission • ORYX® vendor for reporting Core Measures • 1 of only 14 ORYX Vendors Piloting e-Measures • CMS • Q-Net vendor for Quality reporting • Fully Engaged in the Quality Enterprise • Voting Member of the National Quality Forum • Chair HIMSS NQF Taskforce (Patient Safety • and Quality Committee) • Member CMS Meaningful Use CQM Technical Expert Panel

28. Current State Analysis